Assessment of Clinical and Social Characteristics That Distinguish Presbylaryngis From Pathologic Presbyphonia in Elderly Individuals

Abstract

Importance: An aging population experiences an increase in age-related problems, such as presbyphonia. The causes of pathologic presbyphonia are incompletely understood.

Objective: To determine what distinguishes pathologic presbyphonia from presbylaryngis.

Design, setting, and participants: This was a cohort study at an outpatient otolaryngology subspecialty clinic of a tertiary academic referral center. Participants were consecutive consenting adults older than 74 years without laryngeal pathologic abnormalities who visited the clinic as participants or companions. Patient questionnaires, otolaryngologic, video stroboscopic, and voice examinations were compiled. Patients were divided into groups based on whether they endorsed a voice complaint. Three blinded authors graded stroboscopic examinations for findings consistent with presbylaryngis (vocal fold bowing, vocal process prominence, glottic insufficiency).

Main outcomes and measures: Voice Handicap Index-10, Reflux Symptom Index, Cough Severity Index, Dyspnea Index, Singing Voice Handicap Index-10 , Eating Assessment Tool -10, Voice-Related Quality of Life (VRQOL), and Short-Form Health Survey; face-sheet addressing social situation, work, marital status, education, voice use, transportation; acoustic and aerodynamic measures; and a full otolaryngologic examination, including videostroboscopic imaging.

Results: A total of 31 participants with dysphonia (21 were female; their mean age was 83 years [range, 75-97 years]) and 26 control participants (16 were female; their mean age was 81 years [range, 75-103 years]) completed the study. Presbylaryngis was visible in 27 patients with dysphonia (87%) and 22 controls (85%). VHI-10 and VRQOL scores were worse in patients with pathologic presbyphonia (median [range] VHI-10 scores, 15 (0-40) vs 0 (0-16) and median VRQOL score, 19 [0-43] vs 10 [10-23]). All other survey results were indistinguishable, and no social differences were elucidated. Acoustic measures revealed that both groups averaged lower than normal speaking fundamental frequency (mean [SD], 150.01 [36.23] vs 150.85 [38.00]). Jitter was 3.44% (95% CI, 2.46%-4.61%) for pathologic presbyphonia and 1.74% (95% CI, 1.35%-2.14%) for controls (d = 0.75). Shimmer means (95% CI) were 7.8 2 (6.08-10.06) for the pathologic presbyphonia group and 4.84 (3.94-5.72) for controls (d = 0.69). Aerodynamic measures revealed an odds ratio of 3.03 (95% CI, 0.83-11.04) for patients with a maximum phonation time of less than 12 seconds who had complaints about dysphonia.

Conclusions and relevance: Presbylaryngis is present in most ambulatory people older than 74 years. Some will endorse pathologic presbyphonia that has a negative effect on their voice and quality of life. Pathologic presbyphonia seems to be influenced by respiratory capacity and sex. Further study is required to isolate other social, physiologic, and general health characteristics that contribute to pathologic presbyphonia.

Figure 1.. Average Survey Scores of Pathologic Presbyphonia (Voice Complaints) and Control Groups

Scores for the Short-Form Health Survey (SF-36) were the same for both groups: 102. CSI indicates Cough Severity Index; DI, Dyspnea Index; EAT-10, Eating Assessment Tool; RSI, Reflux Symptom Index; VHI-10, Voice Handicap Index-10; VRQOL, Voice-Related Quality of Life. ^aMedian (range). ^bMean (SD).

Figure 2.. Effect Sizes of Average Survey Scores

CSI indicates Cough Severity Index; DI, Dyspnea Index; EAT-10, Eating Assessment Tool; RSI, Reflux Symptom Index; SF-36, Short-Form Health Survey; VHI-10, Voice Handicap Index-10; VRQOL, Voice-Related Quality of Life.

Figure 3.. Presbylaryngis Findings on Videostroboscopic Examination for Each Patient in Both Groups

A, This panel demonstrates how many participants were found to have each of the 3 presbylaryngis findings and B, This panel demonstrates how many participants in each group had 0, 1, 2, or all 3 of the findings consistent with presbylaryngis.